The missing link between land use and health

If where we live shapes how long and how well we live, then land use and neighbourhood health should be treated as part of the same policy conversation. But the relationship between land use and health, which forms the spatial foundation of neighbourhood wellbeing, remains largely implicit rather than intentional.

In March 2026, the Department of Health and Social Care (DHSC) and NHS England published the long‑anticipated Neighbourhood Health Framework, first signalled in the 10‑Year Health Plan. It marks a clear shift towards neighbourhood‑based delivery, where health services are closer to home, better integrated, and more responsive and accountable to local need.

Just weeks later in April, the Department for Environment, Food and Rural Affairs (Defra) published the Land Use Framework for England. It set out how our finite land should be used more effectively to meet competing national priorities for the built and natural environments. Taken together, the two frameworks articulate complementary ambitions: One focused on how places support healthier lives, the other on how England’s land should work harder for the nation. 

It is notable in the Land Use Framework’s recognition that public sector land delivering public services, including healthcare, is a critical national asset. It is also notable in the Neighbourhood Health Framework’s recognition of spatial planning as part of integrating and co-ordinating neighbourhood health at the sub-regional level as neighbourhood health will be built over time.

Yet these two national frameworks expose the need for stronger national policy alignment between land use and health systems as a means of enabling more effective planning and funding decisions. 

Key questions remain about whether multifunctional land use can realistically integrate the spatial and operational requirements of health infrastructure, given differing interpretations of ‘health’ across scales, and whether planning policy, urban design and funding frameworks are sufficient to incentivise population health improvement. 

Stronger policy alignment would help unlock the benefits of recent and ongoing reforms in both planning and health, as they begin to converge in practice from 2026 onwards. Without it, there is a risk that both frameworks operate in parallel rather than in partnership, limiting their collective ability to address health inequalities at scale, especially to reverse falling healthy life expectancy.

Policy misalignment

From a strategic perspective, the Neighbourhood Health and Land Use Frameworks have missed an opportunity to develop the relationship between land use and health, particularly given that the consultation version of the National Planning Policy Framework (NPPF) was distinctly quiet in reframing the built environment’s role in reducing health inequalities.

It will be interesting to see how much the revised NPPF will meaningfully give explicit policy expression to the Land Use Framework, particularly in terms of food security, climate resilience and natural environments which are key components of health. 

There are some clear opportunities for better strategic scale policy alignment through improved government inter-departmental coordination, potentially through a Joint Ministerial Statement between DHSC, MHCLG and Defra to link health, planning and land use policy. A Joint Ministerial Statement would direct and empower strategic authorities to deliver better, more joined up services in relation to health.

Both frameworks highlight how central spatial, particularly strategic, planning is to their delivery, and raises the question of whether, in the current absence of robust strategic planning, the new frameworks risk adding to the volume of non‑statutory guidance rather than driving real change. 

Positively, the Land Use Framework refers extensively to strategic authorities who now have a statutory duty to reduce health inequalities. However, the Neighbourhood Health Framework says very little in relation to strategic authorities and potential of spatial development strategies (SDS), which is a surprising oversight in the new context. 

The role of strategic planning and the SDS should also not be underestimated, particularly in relation to health as the 10 Year Health Plan is expecting Integrated Care Board (ICB) and strategic authority boundaries to be aligned where possible, and requirement for SDS to consider effect on health and health inequalities. This means that there is greater opportunity for partnership working, data sharing and alignment with policies relating to the wider determinants of health.

At the more local level, town centres and high streets can be a prime opportunity for reducing health inequalities by providing health care services in locations that people visit every day. The opportunity was highlighted in a MHCLG letter to Council Leaders and Chief Executives on the 24th of April 2026 which called for inclusion of neighbourhood health centres in emerging local plans. This will require ICBs and local authorities to collaborate to understand the population health needs within their geographies which will require local authorities in particular to develop this capability within planning teams.

In addition to ensuring policy alignment at a national level, it is critical that the principles behind the Neighbourhood Health and Land Use Frameworks are translated into the development of local plans. Perhaps this should have been better reflected in the proposed NPPF which removed the reference to neighbourhood health that in the current NPPF. 

The Land Use Framework should be akin to sustainable development and be a golden thread running through local plans. As alluded to earlier, local plans will need to respond to the needs of neighbourhood health through robust analysis of population health data which may require upskilling of planners as many of these skills were lost with the abolition of regional planning. 

A key issue is the term “neighbourhood,” which carries different meanings in these two contexts. In planning, the term describes a formally designated area with statutory recognition. Neighbourhood planning bodies, such as parish/ town councils and designated neighbourhood forums, define both the geography and policies for the development and use of land through statutory neighbourhood plans. MHCLG data indicates that at least 1,850 such plans have been adopted across England.

By contrast, under the Neighbourhood Health Framework, the 150 or so health and wellbeing boards that are responsible for leading the preparation of neighbourhood health plans, do not carry the same statutory weight. Neighbourhood health is a more flexible and functionally defined concept.

The divergence in the definition of neighbourhood raises important questions about whether the shared terminology helps to align land-use planning and health policy or instead risks creating confusion and obscuring meaningful integration. A shared, operational definition of ‘neighbourhood’ across planning and health systems will be essential to avoid fragmentation and ensure alignment between spatial and service planning.

Ultimately, both planning reform and neighbourhood health are seeking to address the same challenge: How to create places that support healthier, more resilient communities while reducing pressure on overstretched public services.

Local plans could allow health to move from being a reactive consideration to a core organising principle of development. Instead of simply allocating land for housing, planning authorities could use the new system to plan for walkable neighbourhoods, integrated primary care, green space, active travel, community hubs and healthy housing standards from the outset. With better use of digital planning data and population health insights, the planning system could become a powerful tool for tackling health inequalities and embedding prevention into the built environment.

Funding and delivery constraints

Funding is both the biggest barrier and biggest opportunity to realising healthier places. The multiple factors of the general health determinants do not sit neatly within one department, it requires systems alignment, and effective actions may be reduced as a result in a fiscally constrained environment. 

Could a Joint Ministerial Statement also better empower strategic authorities’ duty to reduce health inequalities develop an approach to allocating the NHS settlement and future Public Health Grant? This would incentivise the support of projects that meet both health and land use goals as Liverpool City Council is aspiring to do through its Health in All Policies Approach and as a Marmot City. 

Is there potential to develop the efficiency of the healthcare estate to provide homes that meet the needs of patients who cannot be discharged? Do we need to think about accounting differently to enable this? Could the Office for Health Improvement and Disparities take oversight of this work, particularly in light of the changing role of NHS England following its reintegration into the DHSC? Or should a Cross‑government Health Disparities Taskforce (similar to the Health Promotion Taskforce in 2022) be developed to support strategic authorities with their duty to reduce health inequalities?

Given that English Devolution and Community Empowerment Act has only just been passed, we are yet to see how strategic authorities can deliver meaningful change in the way health inequalities are addressed through the built environment. We also are yet to see what support they require to deliver the duty and if they have the required resources. 

Do we also need to be looking to the private sector for investment in healthy places, or health promoting places aligned with the housing growth ambition for 1.5 million new homes by the end of this parliament? Is there a role for pension funds? After all, pension funds are interested in long term value, a key theme of the Land Use Framework.

Some funds such as Legal & General have stated that they view themselves as stewards of their own developments. Funds are also becoming increasingly interested in the social value of their investments and so developments that they can invest in which can demonstrably reduce health inequalities using data from strategic authorities could be very attractive.

Taken together, these questions point to a need for reframing funding approaches that can help incentivise prevention, integration and long-term value across both health and land use systems.

Looking ahead, we need a step-change to move beyond siloed thinking and adopt genuinely integrated, systems-based approaches that consider environmental, economic and social pressures together. This would help make clear how long-term land use decisions can create knock-on benefits for population health.

As we await the final NPPF, a wave of new strategic and local plans, alongside ICBs settling into their restructured roles, creates a timely opportunity. This is a chance to reframe land use policy, not as a constraint, but as a proactive tool to support prevention, reduce inequalities, and improve wellbeing.

By addressing the current disconnect, through a stronger focus on neighbourhood health, more integrated spatial planning, better alignment of delivery boundaries, and reformed funding approaches, we can move away from simply managing trade-offs. Instead, we can actively design places that deliver measurable improvements in health outcomes.

Michael Chang is a healthy planning specialist and Associate Town Planner at NHS Property Services. Sophie Hockin is a chartered town planner who specialises in health, planning and place-based strategy. The views expressed are personal and do not represent their employers and affiliated organisations

Michael Chang is speaking about healthy places at the Festival of Place on 10 June at Boxpark Wembley with Saira Ali, Team Leader, Landscape Design and Conservation, Bradford City Council; James Green, Investment Lead, Kajima Partnerships and chair Wongani Mwanza, Architect, Transition by Design Cooperative CIC. Tickets on sale now